Hospitals Dispute Rural Health Findings

An independent group set up by Congress to report on the Medicare program finds that health care in rural America is not that much different from care in the cities. Rural hospitals beg to differ.

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An independent congressional agency given the job of reporting on functioning of Medicare has issued a report finding that access to care and quality of care does not vary much from rural to urban areas and that payments to rural physicians are “at least as adequate as those made to urban physicians.”

Moreover, the Medicare Payment Advisory Commission (MedPAC) finds that some special payments to rural hospitals should not be continued. (The full report can be found here.)

MedPAC’s findings have brought a strong reaction from rural health care groups. “The National Rural Health Association strongly disagrees with this report,” said Alan Morgan, National Rural Health Association CEO. “Rural patients and providers will ultimately pay the price as rural hospitals will be forced to eliminate services or close their doors if this report is enacted. The Medicare Payment Advisory Commission’s (MedPAC) conclusions are counter to national data. Primary care workforce shortages remain a significant challenge in rural areas.”

The health reform act of 2010 (President Obama’s health care act) required that MedPAC report to Congress on various aspects of rural health care. These findings are contained in the report given to Congress late last week. Here are some of MedPAC’s conclusions:

•(W) ith respect to access, we find large differences in health care service use across regions but little difference between rural and urban beneficiaries’ service use within regions. Rural service use is high in regions where urban use is high, and it is low in regions where urban use is low. Beneficiary satisfaction with access is also similar in rural and urban areas.

•With respect to quality of care, quality is similar for most types of providers in rural and urban areas; however, rural hospitals tend to have below average rankings on mortality and some process measures. Beneficiaries’ satisfaction with quality of care is similar in rural and urban areas.

MedPAC

MedPAC found that a majority of Medicare beneficiaries in these 100 rural counties must travel more than 18 miles to a qualified pharmacy.

• With respect to payment, rural Medicare payments are adequate, in part due to implementation of certain increases in rural hospital payments that followed from recommendations in the Commission’s 2001 report on rural health care. Because of higher prospective payment rates and enactment of the critical access hospital (CAH) program, the number of rural hospital closures has declined dramatically in recent years. However, some rural special payments go beyond the Commission’s recommendations and are not consistent with the set of payment principles we establish in this paper.

• (A)t least when focusing on Medicare beneficiaries, we see no clear evidence that rural beneficiaries are older, sicker, or consistently live in communities with greater poverty.

• While on average we do not see large rural/urban differences, there are some poor rural areas (and some poor urban areas) where the beneficiary population has significant health care needs. For example, the data consistently show that rural and urban individuals age 65 or over in the south central states (AL, KY, MS, and TN) are sicker and poorer than rural and urban individuals in the north central states.

The National Rural Health Association and a coalition of Medicare dependent rural hospitals issued a statement saying the report is “inaccurate” and “harmful to rural Americans.” The groups say that 77 percent of rural counties are defined by the Rural Health Research Center as having a health profession shortage — that 164 counties lack a single primary care physician. And they point to a 2011 federal report finding that, “Rural areas have higher rates of poverty, chronic disease, and uninsurance, and millions of rural Americans have limited access to a primary health care provider.”

Moreover, the groups say that a recent study found that 35 percent of all rural hospitals run at a financial loss.

“MedPAC’s report simply doesn’t match reality,” said Lance Keilers, CEO of Ballinger (Texas) Hospital and 2012 NRHA president. “This report lacks validity; it’s not what I see every day in rural America.”